Stick To It: Pilot study results of an intervention using gamification to increase HIV and sexually transmitted infection screening among young men who have sex with men in California (Preprint)

BACKGROUND In the United States, young men who have sex with men (YMSM) experience a disproportionate burden of HIV and sexually transmitted infections (STIs). Mobile health (mHealth) interventions, including those that incorporate elements of games (‘gamification’), have the potential to improve YMSM engagement in desirable sexual health services and behaviors. Gamification leverages theory and tools from behavioral science to motivate people to engage in a behavior in a context of fun. OBJECTIVE Determine whether an intervention using gamification is acceptable and feasible to YMSM in California and potentially increases repeat HIV/STI screening. METHODS Eligible YMSM were: 1) 18-26 years, 2) born as and/or self-identified as male, 3) reported male sexual partners, and 4) lived in a zip code adjacent to one of the two study clinics in Oakland and Hollywood, California. The gamification intervention, Stick To It, had four components: 1) recruitment (clinic-based and online), 2) online enrollment; 3) online activities, and 4) ‘real-world’ activities at the clinic. Participants earned points through online activities that could be redeemed for a chance to win prizes during HIV/STI screening and care visits. The primary outcomes were acceptability and feasibility measured with participant engagement data and in-depth interviews. The secondary outcome was the intervention’s preliminary effectiveness on repeat HIV/STI screening within 6 months, restricted to the subset of men who provided consent for review of medical records and who had ≥6 months of follow-up. Outcomes were compared to a historical control group of similar YMSM who attended study clinics in the twelve months prior to intervention implementation. RESULTS Overall, 166 (53%) of 313 eligible YMSM registered. After registration, 93 (56%) participants completed enrollment and 31 (19%) completed ≥1 online activity in the subsequent 6 months. Points were redeemed in clinic by 11% of the 166 users (27% and 5% of those recruited in the clinic and online, respectively). Despite modest engagement with the intervention, participants provided a positive assessment of the program in qualitative interviews, with several stating that they were motivated by the inclusion of game elements in the HIV/STI testing experience. The analysis of repeat HIV/STI testing was assessed among 31 YMSM who consented to medical record review and who had ≥6 months of follow-up. During follow-up, 15 (48%) received ≥2 HIV/STI tests compared to 157 (30%) of a historical comparison group of 517 similar YMSM who lived in the same zip codes and who received care at the same clinics before the intervention (OR=2.15, 95% confidence interval: 1.03, 4.47, P=.04). CONCLUSIONS The intervention was feasible and acceptable to study participants. Among the subset of participants recruited in the clinic, repeat HIV/STI screening was higher than a comparison group of similar YMSM attending the same clinic in the prior year. CLINICALTRIAL Clinicaltrials.gov NCT02946164